Natural History of Early, Localized Prostate Cancer

Abstract

Without understanding the natural history of prostate cancer diagnosed at an early, localized stage, patient counseling and clinical management are difficult. The challenge is to maximize the possibilities for survival without extensive overtreatment. Even without initial treatment, only a small proportion of all patients with cancer diagnosed at an early clinical stage die from prostate cancer within 10 to 15 years following diagnosis.^1-3 However, to our knowledge, no study has hitherto adequately analyzed whether patients who escaped metastasis and death during those 10 to 15 years without treatment continue to have an indolent, nonfatal disease course or whether in the long term, tumor progression takes a more aggressive course. Recently, a randomized trial⁴ demonstrated that radical prostatectomy may further reduce the low-death rate in early prostate cancer by approximately 50%. Because it takes several years after operation for this benefit to emerge, age at diagnosis, comorbidity that influences life expectancy, and long-term natural history will determine the potential advantage with radical primary treatment.